0203-0282 (SFD)79935 Anna Rosa Street
LICENSED CONTRACTOR DECLARATION
i I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
768:595 i3 mc,. * A W30103
C4 r ,.,AL
Date ` 't ` Z Signature of Contractor '../ ►7' L
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm urider penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier SF.&TE Fyyj13]) Policy No. 16031016-N
(This section need not be completed if the permit valuation is for $100.00 or less).
(/ I certify that in the performance of the work for which this permit is issued,
I 'shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. //
Date: f5l—t ,.. Ql Applicant `= ' ,:f. F lf..A k.. ;
f
i
Warning: Failure to secure Work ' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to • the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation,
I certify that I have..read this application and state that the above information is
correct. I agree to gomply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for, inspection purposes. ,
Signature (Owner/Agent) i ` Dates '
PERMIT#
BUILDING PERMIT
DATE VALUATION LOT ' '2 `" ' TRACT
-h_ C,- _ _) ,I S45,320M B27tT5 4 28641
JOB SITE
APN
ADDRESS -935 ANNA, IZOSA Ki n=17
64.9-03")0
OWNER
CONTRACTOR/DESIGNER/EN (NEER
nom,1.,P
DCD DEV, DTC dbti DEWRT MU S 1XV.
74-760M011'WAY 111 0200
78.6001AWTIWAY 111
DMIANWM-21ll CA 92213
LA,Qt,I1ai"TA CA. 92253
(76€I)771.3345 (`dilh 2180
USE OF PERMIT
:J?111G3:E1vo''.I Offi Y* "!.'AMWD
NFA - BLIX0.2-7, UNIT M, PLA14 111 . PERMIT 00F.. 'NOT 1NC.I UDZ
POOT.h SPA, BLOCK WALL%' OR DRIV'FWAY APPROACH. H. 1,45% Rt'OU T.COR
1N PLAN CktizC:K:1F#1 FOR MULTIPIX 1%t1.X0CX OF ;x. -LME PLAN TYPE,
TRACT CONSTRUCTION DUID SF
.
CIA,P.A010CARii%OR.T 5'73, Go :;1+'
C ONSTRUC'•'T101'1 FLIC 141.0004.1 103 -DOD fi'3 4S.e0
FLAN CHUCK 1 FIR, 101-00014.39-316
MEC HMICkA1.. PILL 101-000-421-000 $39.40
I.LEC'TR.ICA.L FEE 101-010101-420-000 $65.46
PLUMATHO FF.% 101 -000-4 10-000
STPIONOMOTION PEZ - R1±;SID 101-.000-2x14.1-000
i F + d.r<71'1a13, i1 Ft + r7° i l $i. 9.11Ca
y yre yy 7. q At rp 4,ry Pi )
JLeu?3lJ,t'•!a c-'M•i 3t;i.iJgUC I +i' AND E'LA .il`ffiX ,.,
$2,24*. -..34
e I >"aarccl Ptu PLi.0
MAY U 6 2002 TAL > ' 1a S P2 UR— O
V;1=1.334
i
CYOFLAQUINTA
FINA(dCEDEPT
I IIIIIII VIII III (IIII IIII 16
;.
IE
RECEIPT
DATE
BY.'
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings m' /7• oL S
Ducts
Slab Grade yrjZ 7
Return Air
Steel
Combustion Air
Roof Deck -a y57
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation /,2-�(• o Z �7%
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath (� • Dz
•aa c Io •ate•-� F-7
Final
Finale c
BLOCKWALL APPROVALS
POOLS -SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines -1
Water Piping //� 5�
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection , p
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final.,,
Utility Notice (Perm) CQ Q
COMMENTS:
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 79-935 ANNA ROSA STREET U-54
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction:
Owner of Building: MIRAFLORES, LP
Building Official
VIM
Bldg. Permit No.: 0203-282
Land Use Zone: CR.
Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 05-01-2003
POST IN A CONSPICUOUS PLACE
Ll
--
r I IIIIIII VIII III VIII IIII 17
I IE
INSULATION CERTIFICATE IC -1
`::C ,fir-•alC55 Perml: \'umbar '
Description of Installation
1. ROOF
Qrin T hickness (ircF:cs) \ j t r T is=,:,: Rcsisaace (R -Value) 39
2. CEILING
Bat: o: B1an'cet T y P •"H --L-) E:a-a Namc 'nL
Thic'u:css (irc`;-s` (3" Tt:e ^ a: ^sistar.ce (ti-
Loo -cc Fill Type Brand A 0 0 111
Contractor's r i- installed wciglSJlt /' _lb h4........._ i t�knzss - 7 inches
,Manufacturces installed weight per square foot to achitvc T11 -tri ,al Resistant -e (R -Vale)
3. EXTERIOR WALL
Material Braz d Namc �n c t < <O _
Thickr:css (inches) FZ Thermal Resistance (R -Value) 2 -\q _
B . Exteriori(i�%C�o rr
'Material C yt"S Brand. Name bneA-LLT
Ti.Ic'rness (inches) �j'�— T --,=,a: R-zs;s,a^c! (Z -Value) 1�
RAISED FLOOR
Material
Thickness (inch. -s)
SLAB; FLOORlPERIMETER
I`/�3t:'rlfll
Thickness (inches)
Perir::c:cr Insulation Dcp: (inches)
FOUNDATION VVALI
M.atc:ial E -a -a N2:--
Thicl.ncss (iechcs) T .e nal Resis:arse (R -Value)
Declaration
1 hcrrey cera:`•• that t. -- above i;sul3tier. `.%3s ins:alled Ln :he c _:le:-- 7: _._ z`o•.c !ocaMien is eonfc-mancc with Lie cum:-!
ErerZ, E� cier,c� S or,�.-r� fo: r_sidential buildings (Till_ 2 =a.. 5, C3'i.cni] Coir: 3f Regt a cns) as indiea�t-d on the
C^.�I:I_au: CFCorT:rl;3'C µ _ ]-•�+I:C]ble.
Genf. -al Cor.tnctor (Co. Name) OR Own:.
B. \....._
Tit_..., _l .,:sistar.ce (R -Value)
Baha Na'Me
T: crmnal Resistancz (R -Value)
:cm
C C0 rc^Ts
Date
Sim Ca._
A,j _ " , 2 -'.J i
1^s:ailing Subcontractor (Co. N3m--) OR
&:Neral Cor,tr7c:or (Co. , 3me) OR Own --r
1
I s:311ir� Su`cor.C73ctor (Co. Name) OR
Gcr.e I Ccr::a:ior(Co. Namc) OR Oµ-ncr
A•36
r IIIIIIII VIII IIIIIIIIIIII 10
IE J Standard Notice of Work Completed and Not Completed
NOTICE - All reccommedations may not have been completed. See below- Recommemedations not completed.This form is prescribled by the Structural Pest
Control Board, with whom a copy must be filed by license within 5 days after completion of work under contract.
THIS IS A NOTICE OF COMPLETION ONLY, NOT AN INSPECTION REPORT
ADDRESS OF BLDG STREET CITY: DATE OF COMPLETION
uinta CA 92253
PROPERTY 79-935 Anna Rosa St. La coQcoDE 33 10/22/2002
INSPECTED:
FARMER TERMITE CONTROL AFFIX STAMP TO
P.O. BOX 5155 BOARD COPY ONLY
BELLFLOWER CA 90706
(888) 340 -BUGS (562) 920-7571
FIRM LICENSE NUMBER PR1401 I COMPLETION STAMP NUMBER
Notice of completion
Sent To and date
Owner's Name and Address:
Copies sent to :
This is to certify that the folowing recommendations on the above designated property, as outlined in STANDARD INSPECTION REPORT NO
. date : / / REGISTRATION STAMP NO:
been and/or have not been completed.
Recommendations completed that are in accordance with Structural Pest Control Board's rules and Regulations:
Recommendations completed that are considered secondary measures under section 1992 of Structural Pest Control Board's rules and Regulations:
Recommendations not completed by this firm
Signature
Cost: $ 70-00
Inspection fee: $ 0.00
Others : $ 0.00
Estimated Cost: $
If you have questions regarding the work as outlined above,you should first contact the licensee noted above. Id satisfaction is not obtain you may contact
the Structural Pest Control Board at :
Los Angeles - 213-620-2255
Sacramento - 916-920-5323
You are entitled to obtain copies of all reports and completion notices on this property filed with the Board during the preceding two years upon
payment of a $2.00 search fee to: The Structural Pest Control Board, 1422 Howe Ave.,Ste. 3, Sacramento,Califmnia 95825-3280.
AT13:0920030313
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